The TRICARE Pharmacy Program and Compounded Medications – Update: TRICARE to Delay Implementation for 180 Days

Jul 02 2013

UPDATED August 1, 2013:

Based upon massive beneficiary input, TRICARE is evaluating the issue of pharmaceutical compounds. They are continuing work to ensure both excellent and safe care for all beneficiaries and clear communication with both providers and beneficiaries. To assure success in both of these efforts, TRICARE will delay the implementation of any change in practice on compounded prescriptions for 180 days.

Compounded prescriptions are tailored for individuals by pharmacists. These prescriptions may contain both conventional medications and other ingredients. Many of the included ingredients are not FDA approved.

Those compound prescriptions which contain ingredients that are not FDA approved are the ones that TRICARE is concerned about.


Recently, over 44,000 TRICARE beneficiaries received a notification letter from Express Scripts, informing them that based upon their medication history they are currently, or have recently, used a medication which contains a bulk chemical or bulk powder.  These types of ingredients are most commonly used in what is termed “compound medications” and they will no longer be covered as of the 24th of July.

coughmedicationPharmacy compounding is a practice in which a licensed pharmacist combines, mixes, or alters ingredients of a drug in response to a prescription to create a medication tailored to an individual’s particular needs.  These are usually not readily available nor approved by the Food and Drug Administration (FDA).  This is where the rub is.

For the safety of beneficiaries, when a compound prescription has an ingredient that isn’t FDA approved, TRICARE by law cannot cover the prescription.  This has always been the case, and due to the implementation of new screening software, prescriptions containing these types of ingredients can now be readily identified.

Who typically needs compounded medications?

  • Babies and children, especially preemies, who need medications in extremely small doses, and often need them to treat certain gastro-esophageal diseases.
  • Children, who might need something that is more palatable (fruity flavors can be added).
  • People with allergies to commercial drugs, which often contain lactose.
  • Many elderly and others who need medication in a different form –  for example, a liquid because they have trouble swallowing.

TRICARE Pharmacy provides coverage for a wide range of FDA approved medications.  Many of the bulk chemicals and powders are not FDA approved and thus not covered under the benefit.

If you are still using a FDA non-approved medication it is recommended that you talk with your provider to see if there is an appropriate alternative which is covered.

 

 

50 responses so far

50 Responses to “The TRICARE Pharmacy Program and Compounded Medications – Update: TRICARE to Delay Implementation for 180 Days”

  1. KevinJacksonon 05 Jul 2013 at 6:43 am

    Well talking about the areas surrounding Tennessee than The Compounding Pharmacy of America, Compounding Pharmacy Tennessee have been the best option for the people over there for quite a many years to get side effect free compounded medicines.

  2. Katherineon 05 Jul 2013 at 12:31 pm

    So we get screwed again. This is absolutely ridiculous. Thanks Tri-Care.

  3. Robert Waymanon 05 Jul 2013 at 1:04 pm

    The reason the FDA doesn’t approve some of these bulk powders is because they do not like the term Bio Identical Hormones and prefer we get something from their litter mates in “Big Pharma.” If I had a say, The FDA would be abolished in favor of an organization that was more user friendly. Taking Testosterone (from bulk powder) changed my life for the better and I don’t want the FDA taking that away. I could probably get testosterone from Express Scripts in a different format but from “Big Pharma.” In any case, if I have to pay for it myself, I’m still getting testosterone.

  4. John Clarkon 05 Jul 2013 at 1:12 pm

    SO, not knowing if any of our several ‘scripts are “compounded,” no letter from ES, no prob? Other than ltr, how does one know? Label maybe?

  5. Thomas Pennon 05 Jul 2013 at 1:17 pm

    Your, MOAA, headline for this article is alarming, whereas the article itself leads me to believe that this is being done for the safety of the patient.

  6. Arnold Kendallon 05 Jul 2013 at 1:40 pm

    If my Dr. writes a prescription for a compounded medication that Tricare doesn’t cover and I pay out of pocket, is it still a deductible medical expense on my income tax return?

  7. mary j. dermodyon 05 Jul 2013 at 1:47 pm

    what meds did you drop? i did not receive a list.
    what is a website?

  8. Ralph Grinnellon 05 Jul 2013 at 1:49 pm

    I’m a retired Army Nurse Corps officer. I am currently working as a Family Nurse Practitioner in an underserved population area. The idea that Tricare is not going to cover prescriptions for compound medications is thoughtless. Although it is not common for health care providers to order compounded medications; when it is necessary, it may be critical to prevent possible life threatening complications from the main stream prescription medications.

    Ralph E. Grinnell, Jr. MSN, APRN, FNP-BC

  9. Robert J Quinnon 05 Jul 2013 at 1:52 pm

    I received a letter from Express Scripts telling me that my prescription for Gabapetin 300 MG Capsule was a a mixed compound. My local pharmacist says not so. Is there a listing of what is and is not mixed compounds?

  10. Ken Marxon 05 Jul 2013 at 2:07 pm

    The FDA is not our friend. It consistently approves downright dangerous drugs from the big pharmaceutical companies. Follow the money.

    One problem you didn’t point out: big pharm’s off the shelf versions of things are NOT bio-identical. Even when they’re close, they have a slightly different molecular structure. Many people get no benefit from them, but still have to face dire side effects.

    That’s why compounded medications are so vital. Folks, our government doesn’t care about us. Somehow, we must fight against this FDA nonsense.

  11. Ruth Stepulison 05 Jul 2013 at 2:10 pm

    I have a problem and for the moment it is solved, but I NEED at this time Topiaz for a medical problem and it is not to be covered. I have used the alternative drugs with out results. I know it is more expensive but I need it. The communication with escripts takes a lot of time to get through to someone to talk to.

  12. John Brownon 05 Jul 2013 at 2:52 pm

    Has anyone noticed that our health care has been severely hampered since United Health Care has taken over from TriWest? My wife’s PCM was changed without notice because the doctor failed to send in his authorization request. Her new PCM was a specialist not a general practitioner. Now they say her original PCM is a health care provider but she can’t utilize him because he isn’t authorized under DEERS. She was admitted to the hospital after an emergency room visit then had a follow-on outpatient procedure but United Health Care was very slow to provide the authorization. The excuse that they are in transition is not an excuse after the amount of time that has passed since they were to take over. This is only one instance of problems we have encountered.

    Together with that and our prescription cost being nearly doubled in the last six months is horrible. Obamacare is going to be horrible for military retirees and vets. Who has the keys to the TriCare health care system? For something that wasn’t suppose to change, the no-change policy has failed.

  13. Andrea Chaseon 05 Jul 2013 at 3:03 pm

    Once again Tricare is shorting retirees and military members in order to make a profit. Compounded medications are used because ingredients in regular medications cause more harm than good to sensitive patients. It is a medical need of the patient. Over 44,000 military members and retirees are being effected by this money making decision. Thanks Tricare!

  14. Stephen Leeon 05 Jul 2013 at 3:19 pm

    This TRICARE pharmacy Program which reduces our benefit is a trial balloon to see how much noise we will make as the government starts to slowly erode our entitlement. The type drugs and the target audience have been carefully selected to appear non-intrusive to the veteran sponsor. This is all a sham but it will pull back the “Do not mess with” sign on our medical benefit and once started it will be routinely and rigorously reduced by legislative erosion. The MOAA should not be a party to this fiasco—the MOAA should be out front combating any reduction in benefits. As I write this I am completely convinced our government is now a cancer designed and intent on removing all we were promised when we agreed to serve. We have been leaning the wrong way in the foxhole–the enemy is and has been behind us–we need not deploy or don our battle gear to fight these contract welshers; they are in our Legislatures and we put them there. We must not accept any reductions in our medical benefits.

  15. Charles Walterson 05 Jul 2013 at 4:28 pm

    MOAA – time for you take the reins again. The Obama Administration continues to chip away at retiree benefits. At the same time, he and they continue to espouse their appreciation and support for our military, active, retired, veterans. They want it both ways but can’t get it. Their solution is to take more of our retirement money by reneging on the promises they made us – no cost medical care for our lifetime. I enlisted in 1964 and that was thrown at me by the recruiter. At the time, it meant nothing. Four years later, it was thrown at me as a re-enlistment incentive. I was just married. Instead of re-enlisting, I went to college on the GI Bill with focus on a commission via the Marine Corps PLC program – lifetime medical was a key reason to return to active duty and spend a total of 27 years in a Marine Corps uniform.

    Where are our Service chiefs on this issue. They, as usual, remain silent to avoid ticking off Obama. Someone has to take the reins and stop this insanity!! Please take up the task. Thank you.

    LtCol USMC

  16. Jeff Vandineon 05 Jul 2013 at 4:59 pm

    While this doesn’t affect me personally, it is still BS. When a doctor prescribes a medication, he does so for the best possible effect on his patient’s medical condition. For Tricare to then turn around and state that they will not cover a PRESCRIBED medicine, is simply buffoonery of the worst sort and a direct slap in the face of the person needing the care. MOAA, we need the same kind of letter writing campaign against this that you have us do for other issues. This is IMPORTANT — not only for those of us now in the position of being at Tricare’s mercy, but also for the future generations who will suffer if we don’t act!

  17. Dick Joneson 05 Jul 2013 at 5:05 pm

    So, MOAA, what can we expect from you in retaliation?

    Will messages to our Congressmen be effective?

    This doesn’t apply to me at the moment but, I can see where it can be costly to those who cannot live comfortably without the compounded medications.

    Please, guys, you gotta start the ball rolling………

  18. Charles E. Dykeson 05 Jul 2013 at 5:36 pm

    Anything that will keep us guessing as to what is covered what is not.
    Thanks

  19. Cynthia Kuhnson 05 Jul 2013 at 6:10 pm

    After all this time Tricare has determined my medicine isn’t FDA approved? Who discovered this? No one discovered this. Big Pharma has been trying to get rid of compounding pharmacies for years. My pharmacy told me it was FDA approved. It seems we can no longer believe anyone in our government and that is really sad. We as American citizens have a lot of work to do in the next few years, at the polls. Thanks Tricare, you raised my copay, now you are taking away my medicine, what is next???????????????

  20. Byron Cyron 05 Jul 2013 at 7:23 pm

    I received a letter telling e that one of my prescritions was being moved to a Tier III which means initial prescriptions and all refills need prior authorization. However, when I go to the formulary where you are suppose to click beside the medication and print out the prior authorization form, the medication is not listed. Therefore, no form! Repeated requests for help have been fruitless.

  21. Mark witton 05 Jul 2013 at 7:37 pm

    When do some retirees stop whining?
    At least most responded with a view that it is for our benefit.

    Reminds me of the retired general that was surprised he could no longer get aspirin at the base pharmacy.

  22. Bob Gruenhagenon 05 Jul 2013 at 8:48 pm

    I was prescribed a compound topical solution for arthritus knee pain in March of 2013. Used the solution for thirty days with no pain relief and a rash irritation which turned the area bright red. I stopped the treatment and used OTC cortisone cream to control the rash and itching. I consulted the pharmacist that prepared the compound and he reversed the charges and I returned the unused containers of the compound. I received the letter which described the drug, Flurbiprofen,
    which was an ingredient of my presciption as not FDA approved.
    I had not intended to use any of the solution and was relieved to learn by letter that it would not be refilled.
    One of your writers thinks 44,000 users will be affected by this ruling. If you all check the cost of this “benefit” you would know we would soon break the bank. The Pentagon and the armed services committees review our costs and can change the pharmacy drugs and co-pays.

  23. Lindaon 06 Jul 2013 at 12:57 am

    Jeff, your comment “When a doctor prescribes a medication, he does so for the best possible effect on his patient’s medical condition.” is not accurate. Doctors get kickbacks for prescribing certain medications.

  24. CAPT Kathryn M. Beasley, USN.Ret.on 06 Jul 2013 at 6:09 am

    Robert,
    I am not aware of any listing but I would urge you to discuss an alternative with your physician or healthcare provider. They would be aware of a suitable alternative.

  25. CAPT Kathryn M. Beasley, USN.Ret.on 06 Jul 2013 at 6:10 am

    Ralph,
    I am under the impression that not all compounded medications will be restricted. ONLY those with un-approved FDA ingredients.

  26. CAPT Kathryn M. Beasley, USN.Ret.on 06 Jul 2013 at 6:10 am

    Arnold,
    I would think it would be is the tax provision for medical expenses applies to you and your circumstances.

  27. CAPT Kathryn M. Beasley, USN.Ret.on 06 Jul 2013 at 6:20 am

    Bob,
    Thank you for commenting on your experience. This is precisely why the use of non-FDA approved compounds is, by law, restricted by TRICARE reimbursement. There are unknown and untoward side effects which may result from ingredients from bulk manufacturers. It is not about the practice of compounding, which many rely upon and I have cited them in the article, it is about the unknown of non-FDA inspected substances.

    The FDA is too busy and over-loaded to inspect small doses of individually prescribed medications.

  28. George W Kahrson 06 Jul 2013 at 9:15 am

    I have had two incidents with Express Scripts in the last 60 days. I tried to get ahead of the mandatory use of mail order by having my doctor send in all new prescriptions for the drugs I use each month. ExScripts said it was NOT mandatory and that no date had ever been set. Why all the panic in the newsletters then?

    When filling the first 90 day supply, they did not have the generic I asked for in stock so sent the brand name. At refill time, they refused to fill it as it was a brand name, not a generic. Took 45 minutes and one bump up to a supervisor to get it done. It is one of the two drugs I take to keep my heart functioning correctly.

    Second, I have an old fashioned vitamin complex Metanx, which was prescribed for my foot pain about 7 years ago. ExScripts said it was no longer made. Then they backed up and said it was no longer available in tablet only capsule. They they just said: “It is no longer covered and you can’t have it”.
    My pharmacist has no trouble getting it and it is reasonable so I pay for it myself. Isn’t that what this is all leading to – pass the cost on to us?

    MOAA needs to evaluate their position on our Tricare Pharmacy benefits. I too was told (and even in writing on my second enlisted re-enlistment, that I would have FREE Medical care for life. My responses from you in each of the above cases was to take the ExScripts side and sometimes not even understanding the problem.

    I have a heart drug that keeps me alive and well. If they take it off the list (Tier III) and say I can’t have it, then the doctors and nurses at United that make the decisions (the ones that can’t work anywhere else due to their lack of competence) will become the “death squad” instead of Medicare.

    Where are our service chiefs, someone asked? Beats me, the USAF chief of staff NEVER attends the memorial day tribute held every year. But I know where the Chairman is. He sings the National Anthem at baseball games – and quite well too.

    George W Kahrs
    Captain, USAFRet
    Life Member MOAA
    100% disabled from Agent Organge
    Viet Nam Vet with Bronze Star

  29. pamela tennanton 06 Jul 2013 at 9:40 am

    This will cost me nearly $100 a month for my compounded medications. Will I be able to continue on them? I doubt it.

  30. Eric Parkeron 06 Jul 2013 at 11:00 am

    The problem as I see it is that Express Scripts has been directed to drop coverage for medications where the form of the medication is different from the standard commercially available form.

    As an example, my Gastro-Intestinal Specialist has prescribed Ketotifen, which is an FDA approved medication. The problem is that he is prescribing for a GI issue, but the only form that is currently commercially available is eye drops. Needless to say, that is not a form that is effective to take internally, so he sends me to a compounding pharmacy, and I get the medication in the form I need.

    You article mentions several examples of people who need compounded medications, but no mention of a process for approval for exceptions to get exceptions to the new policy. What are those people supposed to do if there is not a commercially available form of the medication they need the way they need it?

    If these alternate forms of the medication are in fact shown to be ineffective and possibly dangerous, wouldn’t the FDA have ordered them removed from the market? If they are not controlled, why does it specifically state that they are combined, mixed or altered by a licensed pharmacist?

    Does this mean that Generic forms of previously approved medications should not be able to rely on the previous testing and have to be re-approved from scratch, because that is the implication to me?

    In my opinion, this move was made to save money, not protect people.

  31. CAPT Kathryn M. Beasley, USN.Ret.on 06 Jul 2013 at 11:49 am

    Eric,

    You raise some very good questions. It sounds like your compounding medication ingredients may already be FDA approved and did not trigger a letter from ESI. Is this the case? as not every compounded medication will trigger a non-FDA approved bulk ingredient.

    Generic medications are different than what we are referring to with medications that require “compounding”. Generics are manufactured using a standardized process with (if they are FDA approved) ingredients which have been approved.

    This move (which by the way many health plans have incorporated) has been the result of several medications which have caused serious infections….anyway it is a safety precaution.

  32. Tilden A Mitchell IIIon 06 Jul 2013 at 12:15 pm

    I recently received such a letter from Express Scripts on behalf of Tricare.

    I interpreted the letter to say that a specific ingredient, KETAMINE HCL POWDER, of a recent medication prescribed by my pain clinic doctor as a component of the compounded back cream I have used most recently for back pain relief, would not be funded by Tricare after 24 July 2013.

    I provided a copy of that letter to both the compounding pharmacy and my pain clinic doctor because I thought the letter gave references for this action and a place that a pharmacist or doctor could check for alternative FDA approved products that would be supported.

    My doctor has notified me that there is an alternative bulk powder but I do not yet know if he and the pharmacy checked to ensure the alternative will, in fact, meet Tricare approval nor have I used the alternative medication.

    I was referred to a pain clinic by my regular internal medicine doctor because, together, over the last ten years, many of the oral medications for pain I have taken eventually caused internal side effects that became intolerable or life-threatening (renal failure).

    I am 75 years old and have had two back surgeries (neck and lower back). I do not want to have any other back surgeries if I can avoid them. The new cream gave me relief from back pain for the day so I can do the chores necessary to live in my own home.

    I only recently received a Tricare Summary of Prescriptions Filled which showed the dollar amount submitted by the compounding pharmacy for my initial 30 days supply of the cream. I was truly shocked by the amount, $3,363.84, and called the pharmacy to see if this was correct. They said it was correct, but an error that was later corrected, brought the amount down to $2670.00 for a 30 day supply. This stuff is extremely expensive and I could not afford to pay for it on my own.

    Maybe it is time to see if a back operation would be the answer, heal me or kill me.

  33. Don MIlleron 06 Jul 2013 at 4:55 pm

    If someone’s giving financial or in-kind rewards to docs who prescribe certain medicines, they haven’t contacted me yet!

    COL, MC USA-RET

  34. CAPT Kathryn M. Beasley, USN.Ret.on 06 Jul 2013 at 4:57 pm

    Tilden,

    Many thanks for describing your experience. You did exactly what is recommended – you discussed this with your provider and he researched a potential alternative ingredient for your back medication. Please let us know how you fare with this and if it is indeed approved. Seems like this would be preferable to more back surgery.

  35. Chainmailon 06 Jul 2013 at 9:22 pm

    Quit your whining. We still have a better deal than anyone else.

  36. Mary Frances Woodon 06 Jul 2013 at 10:55 pm

    Just another attempt by the FDA and pharmaceutical companies to get us to use FDA approved drugs that are “safe”….look at the commercials that show just how safe their approved drugs are….some of them state “some have died after taking this drug; not safe for people with xxx or yyy” I have been using bio-identical HRT for over two years and they have been excellent in stopping the effects of menopause, but now I will have to pay for them myself or use FDA-approved products manufactured from synthetics or the urine of pregnant mares. I’ll buy them myself, thank you.

  37. Mary Frances Woodon 06 Jul 2013 at 11:13 pm

    Here is an FDA-approved drug that has multiple side effects. Like many, my husband was promised FREE health care for life…another breach of faith by the US Government…..

    XELJANZ MEDICATION
    IMPORTANT SAFETY INFORMATION

    What is the most important information I should know about XELJANZ?

    XELJANZ may cause serious side effects including:

    Serious infections. XELJANZ can lower the ability of your immune system to fight infections. Some people have serious infections while taking XELJANZ, including tuberculosis (TB), and infections caused by bacteria, fungi, or viruses that can spread throughout the body. Some people have died from these infections. Your healthcare provider should test you for TB before starting XELJANZ, and monitor you closely for signs and symptoms of TB infection during treatment. You should not start taking XELJANZ if you have any kind of infection unless your healthcare provider tells you it is okay.
    Cancer and immune system problems. XELJANZ may increase your risk of certain cancers by changing the way your immune system works. Lymphoma and other cancers can happen in patients taking XELJANZ. Tell your healthcare provider if you have ever had any type of cancer.

    Some people who have taken XELJANZ with certain other medicines to prevent kidney transplant rejection have had a problem with certain white blood cells growing out of control (Epstein Barr Virus-associated post transplant lymphoproliferative disorder).

  38. Karl K. Russellon 08 Jul 2013 at 3:34 pm

    This is absolutely ludicrous!! Where do these folks think the whole pharmaceutical program started. A Doctor would send a patient to the local drug store to have the chemist (pharmacist) specially blend bulk chemicals to make the desired remedy. Now we can’t get this same service because it is not done by a recognized pharmaceutical manufacturer.
    Perhaps if Tricare, and our representatives (both congressional and the services) would stand up for those in need, the pharmaceutical manufacturers would be forced to produce the required modifiable medications along with acceptable modifiers so that patients can receive the medications that produce the desired effects.

  39. Charles Carteron 09 Jul 2013 at 2:00 pm

    In some cases, The more effective “compound” medications have fewer detrimental side effects than their alternate medications.

  40. CAPT Kathryn M. Beasley, USN.Ret.on 09 Jul 2013 at 3:56 pm

    We are currently asking the Department if there will be an appeals process or a method of obtaining exceptions. We will keep our members updated as information becomes available.

  41. Phil L. Samples, Colonel, USAF (retired)on 15 Jul 2013 at 8:36 am

    Reference the original issue – compounded medications no longer covered as a Tricare pharmacy benefit due to legal opinion that only FDA approved mediations are a covered benefit.

    I served as the 10th Pharmacy Consultant to the USAF Surgeon General, 2003-2005. Bottom Line Up Front (BLUF) – I do not believe the original intent of the law was to prohibit physicians and pharmacists from practicing the art of medicine by restricting National Formulary (NF) approved chemicals in compounded delivery vehicles. It is my opinion the purpose of the law was to ensure only FDA approved medications were dispensed to our personnel, particularly those serving in OCONUS settings and not to prevent the art of medicine. There have been significant discussion over the years regarding patients referred to local physicians in England, Germany, or any other OCONUS locations and how to deal with prescriptions from these physicians IF they did not prescribe an FDA approved medication. Needless to say it was, and continues to be, a challenge to pharmacists and physicians who then coordinate this care after the host country referral. This was the original intent of the law. If the law were intended to cover compounded medications it would have done so when written. We compounded and dispensed NF approved bulk chemicals to DOD patients my entire career. For those who compounded medications, there is a very formal and strict process for these compounded medications. Restating my BLUF – I believe this recent decision is a vast over interpretation of the law.

    It would be great if the National Institutes of Health (NIH) would undertake studies of some of the more sophisticated and long-standing compounded items like those used in women’s health issue that include bulk chemicals (NF approved) like DHEA and testosterone. However, I would not stop with only those medications. There is no profit incentive in compounded medications from the pharmaceutical industry and therefore funding for studies needed to produce “FDA approved,” will never come from that venue.

    I believe the MOAA position should be to advocate for medications that are compounded under the strict guidelines of compounding pharmacies using NF approved bulk powders prescribed by a licensed provider with proven experience prescribing and monitoring the effects of these medications.

  42. Phil L. Samples, Colonel, USAF (retired)on 15 Jul 2013 at 2:10 pm

    Addendum to my earlier post for background. The FDA has authority over US manufactured pharmaceuticals and those foreign manufacturers who sell or intend to sell their products in the United States and submit to FDA criteria. This includes oral tablets and capsules, oral liquids, topical creams, gels, liquids and ointments, etc. The FDA does not have inspection authority over all foreign manufacturers and therefore cannot attest to the sterility and quality controls of their products. These medication are then not “FDA approved”. They may have the same generic chemical compound in a stated strength and may be even marketed in North America, but they are not FDA approved and cannot legally be sold in the United States. The military system is prohibited from purchasing and pharmacies are prohibited from dispensing anything other than FDA approved pharmaceuticals as noted above. The military system has always been able to purchase all the ingredients needed to compound National Formulary (NF) bulk powders and dispense them in accordance with professional standards and practice. Additionally, the United States Pharmacopeia (USP) has guidelines for compounding practice.

    So, when I noted “only FDA approved medication dispensed to our patients” I was referring to pharmaceuticals manufactured by a foreign, “none FDA approved,” manufacturer.

  43. Ann L. Piercy, Major, USAF, (ret.)on 26 Jul 2013 at 1:33 pm

    Dear Col. Samples,

    You seem to be very knowledgeable on this issue. I have been prescribed bio-identical compound medications by Wright-Patterson AFB Medical Center since last year with very good results (testosterone cream and DHEA). I asked for the ingredient list for these prescriptions. I am still somewhat confused about who to address these issues to and also is the real question that bulk testosterone powder, for example, is not FDA approved but an FDA registered ingredient and a USP monographed ingriedient? Is this bulk powder of this type listed in the National Formulary (NF)? Any help would be greatly appreciated.

  44. Joeon 27 Jul 2013 at 2:52 pm

    Prior to taking HRT’s my wife almost died from taking FDA approved medications. What was interesting is that every traditional physician she visited administered countless test and prescribed medications that resulted in complicating her conditions by using FDA approved medications. When she finally got to the point of no return only an HRT doctor was able to resolve her issues at a reduced cost. Now that she has found her best course of action for her physical, emotional, and spiritual well being Tricare has decided not to cover her compounded HRT’s. Now let me try to figure this one out.

    1. Emergency Room visits average $3,000 to $4,000
    2. Ex-rays, blood test, MRI’s, scans, EKG, medicines, follow-up, etc……. another few thousands

    HRT’s average $80.00 to $100 per month.

    Patient is healthy?

  45. Joeon 27 Jul 2013 at 2:52 pm

    Prior to taking HRT’s my wife almost died from taking FDA approved medications. What was interesting is that every traditional physician she visited administered countless test and prescribed medications that resulted in complicating her conditions by using FDA approved medications. When she finally got to the point of no return only an HRT doctor was able to resolve her issues at a reduced cost. Now that she has found her best course of action for her physical, emotional, and spiritual well being Tricare has decided not to cover her compounded HRT’s. Now let me try to figure this one out.

    1. Emergency Room visits average $3,000 to $4,000
    2. Ex-rays, blood test, MRI’s, scans, EKG, medicines, follow-up, etc……. another few thousands

    HRT’s average $80.00 to $100 per month.

    Patient is healthy?

  46. Johnon 28 Jul 2013 at 4:12 pm

    Express scripts (tricare pharmacy benefit management) has distinct profit motive to move away from compounded products to orals (which they have). There are over 200 oral pills that express scripts and tricare reimburse today that are not fda approved (pre date 1938 formation of FDA). I agree with the contributor who detailed how pharmacies in the 1950’s and 1960’s compounded medicines routinely. I worry about the author of this article who selectively responds to contributors who support his stance only. There is a place for compounding and tricare is denying all of it, or creating real patient and provider burdens to seek approval- all of these denials and approving pharmacists/techs cost real money. Express scripts want more oral scripts by denying compounding rx or making it difficult to get them. Why are you supporting this?

  47. Dan Kingon 06 Aug 2013 at 10:05 am

    “Compounded” prescriptions have been around since the dawn of time. Great plan to eliminate them and leave the compounding up to us untrained amateurs at home as caregivers. What could possibly go wrong with that plan? For all the complaining about big government, medicine is one area where we NEED the federal government to step up and do their job. Unfortunately, this would require our dysfunctional congress to get off their collective butts and do their job too; not likely.

  48. Alice Tireyon 09 Aug 2013 at 4:35 pm

    I hope that more care will be taken when filling prescription for gluten free meds. Because tricare uses generic drugs, many are not glutinous free due to the fillers often used. I feel safer dealing with my local pharmacy even though I have the inconvience of only able to get a month supply.

  49. Alice Tireyon 09 Aug 2013 at 4:35 pm

    I hope that more care will be taken when filling prescription for gluten free meds. Because tricare uses generic drugs, many are not glutinous free due to the fillers often used. I feel safer dealing with my local pharmacy even though I have the inconvience of only able to get a month supply.

  50. John Clarkon 09 Aug 2013 at 9:55 pm

    Broad view from non-scientist (always good to have “see the forest” types earning our keep! :-) :
    1. Well-done, empirical SCIENCE — NOT “over-the-fence. cocktail party” anecdotal here-say (too often seasoned w/ a big measure of anti-govt, conspiracy theories…) should be the overriding factor in “What’s safe & effective; what’s not?” That means, at minimum, to be based on NON-biased or “steered,” peer-reviewed, double-blind, etc. studies.

    2. HOWEVER, the best offerings from non-traditional/homeopathic/”alternative” sources most definitely should be included — AS LONG AS they pass “good science” muster.

    3. Finally, in our bigger real-world ‘forest’ of over-arching national Deficit in face of “Nation-killer” strategic threats only kept at bay by our Armed Forces’ muscle, COST TRADEOFFS ARE CRITICAL.

    As important as my loved ones and I personally am in my own eyes here in my own ‘tree,’ in truth it’s the safety & health of the whole forest that really counts.